Skip to main content

Advertisement

SpringerLink
Log in

Recent trends in the prescription of opioids in the emergency department in patients with urolithiasis

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Pain management is central in the treatment of urolithiasis. We aimed to estimate the impact of the 2017 Department of Health and Human Services declaration of an opioid crisis on prescribing patterns of opioids and NSAIDs in emergency department visits for urolithiasis.

Methods

The National Health Ambulatory Medical Care Survey (NHAMCS) was queried for emergency department visits of adults with a diagnosis of urolithiasis. The association between urolithiasis and narcotic and NSAIDs prescription patterns was evaluated and compared at pre-declaration (2014–2016) to post-declaration (2017–2018) periods.

Results

Opioids were prescribed in about 211 million (41.1%) out of 513 million emergency department visits, over a 5-year period. Diagnosis of urolithiasis accounted for 1.9% of the visits (6.0 million). The use of opioids was higher in urolithiasis (82.7%) compared to non-urolithiasis diagnosis (40.3%), as well as the use of multiple opioids per visit (p < 0.01 for all). There was an overall decrease in opioid prescriptions in the post-declaration period, − 4.3% for urolithiasis (p = 0.254) and − 5.6% for non-urolithiasis visits (p < 0.05). A decrease in the use of hydromorphone (− 47.5%. p < 0.001), an increase in the use of morphine (+ 59.7% p = 0.006), and an increase of ‘other’ opioids (+ 98.8%, p < 0.041), were observed. Opioids combined with NSAIDs comprised 72.6% of the opioid prescriptions and 62.3% of all analgesic prescriptions in visits with urolithiasis diagnosis.

Conclusions

The use of opioids when managing urolithiasis decreased 4.3% after the crisis declaration; however, statistically are not different from pre-declaration numbers. Most often, opioids were prescribed with NSAIDs in urolithiasis patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Data Availability Statement All data underlying results are publicly available through the Center for Disease Control website below under the National Health Ambulatory Health Care Survey. Source Data: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/NHAMCS/.

References

  1. United States Government Accountability Office. Opioid Crisis: Status of Public Health Emergency Authorities . https://www.gao.gov/products/gao-18-685r. Published October 2018. Accessed 26 July 2021.

  2. Kiechle JE, Gonzalez CM (2018) The opioid crisis and urology. Urology 112:27–28. https://doi.org/10.1016/j.urology.2017.10.009

    Article  PubMed  Google Scholar 

  3. Guy GP, Zhang K, Bohm MK et al (2017) Vital signs: changes in opioid prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep 66(26):697–704. https://doi.org/10.15585/mmwr.mm6626a4

    Article  PubMed  PubMed Central  Google Scholar 

  4. Busse JW, Craigie S, Juurlink DN et al (2017) Guideline for opioid therapy and chronic noncancer pain. Can Med Assoc J 189(18):E659–E666. https://doi.org/10.1503/cmaj.170363

    Article  Google Scholar 

  5. Manchikanti L, Helm S, Fellows B et al (2012) Opioid epidemic in the united states. Pain Physician 15:9–38

    Article  Google Scholar 

  6. Scales CD, Smith AC, Hanley JM, Saigal CS (2012) Urologic diseases in america project prevalence of kidney stones in the United States. Eur Urol 62(1):160–165. https://doi.org/10.1016/j.eururo.2012.03.052

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sfoungaristos S, Kavouras A, Perimenis P (2012) Predictors for spontaneous stone passage in patients with renal colic secondary to ureteral calculi. Int Urol Nephrol 44(1):71–79. https://doi.org/10.1007/s11255-011-9971-4

    Article  PubMed  Google Scholar 

  8. Meltzer AC, Wolfson AB, Mufarrij P et al (2021) Analgesic and opioid use for patients discharged from the emergency department with ureteral stones. J Endourol 35(7):1067–1071. https://doi.org/10.1089/end.2020.0835

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hosier GW, McGregor T, Beiko D et al (2020) Persistent opioid use among patients with urolithiasis: a population based study. Eur Urol Focus 6(4):745–751. https://doi.org/10.1016/j.euf.2019.08.011

    Article  PubMed  Google Scholar 

  10. Kea B, Fu R, Lowe RA, Sun BC (2016) Interpreting the national hospital ambulatory medical care survey: United States emergency department opioid prescribing, 2006–2010. Acad Emerg Med 23(2):159–165. https://doi.org/10.1111/acem.12862

    Article  PubMed  PubMed Central  Google Scholar 

  11. Shoag JE, Patel N, Posada L et al (2019) Kidney stones and risk of narcotic use. J Urol 202(1):114–118. https://doi.org/10.1097/JU.0000000000000197

    Article  PubMed  Google Scholar 

  12. Pathan SA, Mitra B, Cameron PA (2018) A systematic review and meta-analysis comparing the efficacy of nonsteroidal anti-inflammatory drugs, opioids, and paracetamol in the treatment of acute renal colic. Eur Urol 73(4):583–595. https://doi.org/10.1016/j.eururo.2017.11.001

    Article  CAS  PubMed  Google Scholar 

  13. Minhaj FS, Hoang-Nguyen M, Tenney A et al (2020) Evaluation of opioid requirements in the management of renal colic after guideline implementation in the emergency department. Am J Emerg Med 38(12):2564–2569. https://doi.org/10.1016/j.ajem.2019.12.042

    Article  PubMed  Google Scholar 

  14. Motov S, Drapkin J, Butt M et al (2018) Analgesic administration for patients with renal colic in the emergency department before and after implementation of an opioid reduction initiative. West J Emerg Med 19(6):1028–1035. https://doi.org/10.5811/westjem.2018.9.38875

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kominsky HD, Rose J, Lehman A et al (2020) Trends in acute pain management for renal colic in the emergency department at a tertiary care academic medical center. J Endourol 34(11):1195–1202. https://doi.org/10.1089/end.2020.0402

    Article  PubMed  PubMed Central  Google Scholar 

  16. Centers for Disease Control and Prevention. Ambulatory Health Care Data: About the Ambulatory Health Care Surveys. https://www.cdc.gov/nchs/ahcd/about_ahcd.htm. Published September 6, 2019. Accessed 11 Nov 2021.

  17. Fwu C-W, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z (2013) Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States. Kidney Int 83(3):479–486. https://doi.org/10.1038/ki.2012.419

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hosier GW, McGregor T, Beiko D et al (2020) Increased risk of new persistent opioid use in pediatric and young adult patients with kidney stones. Can Urol Assoc J 14(8):237–244. https://doi.org/10.5489/cuaj.6796

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rosenbloom JM, Burns SM, Kim E, August DA, Ortiz VE, Houle TT (2019) Race/ethnicity and sex and opioid administration in the emergency room. Anesth Analg 128(5):1005–1012. https://doi.org/10.1213/ANE.0000000000003517

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wentz AE, Wang RRC, Marshall BDL, Shireman TI, Liu T, Merchant RC (2020) Variation in opioid analgesia administration and discharge prescribing for emergency department patients with suspected urolithiasis. Am J Emerg Med 38(10):2119–2124. https://doi.org/10.1016/j.ajem.2020.07.016

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mazer-Amirshahi M, Ladkany D, Mullins PM et al (2018) Trends in and predictors of hydromorphone administration in US emergency departments (2007–2014). J Opioid Manag 14(4):265–272. https://doi.org/10.5055/jom.2018.0458

    Article  PubMed  Google Scholar 

  22. Jasani NB, O’Conner RE, Bouzoukis JK (1994) Comparison of hydromorphone and meperidine for ureteral colic. Acad Emerg Med 1(6):539–543. https://doi.org/10.1111/j.1553-2712.1994.tb02549.x

    Article  CAS  PubMed  Google Scholar 

  23. Abril Ochoa L, Naeem F, White DJ, Bijur PE, Friedman BW (2020) Opioid-induced Euphoria Among Emergency Department Patients With Acute Severe Pain: An Analysis of Data From a Randomized Trial. Acad Emerg Med 27(11):1100–1105. https://doi.org/10.1111/acem.13946

    Article  PubMed  Google Scholar 

  24. Walsh SL, Nuzzo PA, Lofwall MR, Holtman JR (2008) The relative abuse liability of oral oxycodone, hydrocodone and hydromorphone assessed in prescription opioid abusers. Drug Alcohol Depend 98(3):191–202. https://doi.org/10.1016/j.drugalcdep.2008.05.007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Yazdani P (2021) Comparative study of individual pain relief effect of intravenous ibuprofen intravenous morphine, intravenous ketorolac separately in renal colic patient. J Critical Rev. 8(2):278–284

    Google Scholar 

  26. Sobel DW, Cisu T, Barclay T, Pham A, Callas P, Sternberg K (2018) A retrospective review demonstrating the feasibility of discharging patients without opioids after ureteroscopy and ureteral stent placement. J Endourol 32(11):1044–1049. https://doi.org/10.1089/end.2018.0539

    Article  PubMed  Google Scholar 

  27. Fedrigon D, Faris A, Kachroo N et al (2021) SKOPE-Study of ketorolac vs opioid for pain after endoscopy: a double-blinded randomized control trial in patients undergoing ureteroscopy. J Urol 206(2):373–381. https://doi.org/10.1097/JU.0000000000001772

    Article  PubMed  Google Scholar 

  28. Gridley C, Robles J, Calvert J et al (2020) Enhanced recovery after surgery protocol for patients undergoing ureteroscopy: prospective evaluation of an opioid-free protocol. J Endourol 34(6):647–653. https://doi.org/10.1089/end.2019.0552

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank all faculty at Mount Sinai Medical Center, NOVA Southeastern, Florida International University and Thomas Jefferson University for their collaborative mentorship with this study.

Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Mount Sinai Medical Center, Columbia University Division of Urology, 4302 Alton Road, Suite 540, Miami Beach, FL, 33140, USA

    Spencer S. Liem, Timothy Demus, Alejandra Perez & Jorge F. Pereira

  2. Departments of Socio-Behavioral-Administrative Pharmacy, and Pharmaceutical Sciences, Nova Southeastern University, Davie, FL, USA

    Alexandra Perez & Luigi Cubeddu

  3. Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA

    Dhaval Jivanji & Kevin A. George

  4. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Crystal Y. Lee

Authors
  1. Spencer S. Liem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy Demus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandra Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dhaval Jivanji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Crystal Y. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kevin A. George
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alejandra Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luigi Cubeddu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jorge F. Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SL Project development, Data collection, Data Analysis, Manuscript Writing/Editing, TD, AP, JP, Project development, Data collection, Data Analysis, Manuscript Writing/Editing. DJ, KG, AP, LC, Data Analysis, Manuscript Writing/Editing. CL Data collection, Data Analysis, Manuscript Writing/Editing.

Corresponding author

Correspondence to Jorge F. Pereira.

Ethics declarations

Conflicts of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The data used in this study was publicly available and de-identified; thus, in accordance with federal legislation dealing with publicly available data, Institutional Review Board (IRB) approval for this study was not required. No Institutional Review Board approval was required for this study.

Registry number

N/A

Animal Study

N/A

Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liem, S.S., Demus, T., Perez, A. et al. Recent trends in the prescription of opioids in the emergency department in patients with urolithiasis. Int Urol Nephrol 55, 1109–1116 (2023). https://doi.org/10.1007/s11255-023-03545-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-023-03545-w

Keywords

Search

Navigation